Trauma

Shock

Pathophysiology

  • Shock is the inadequate perfusion of cells.

  • Hemodynamic instability (blood dynamic unstable)

  • Pump → container → fluid volume

  1. heart not functioning effectivly

  2. vessels are unable to constrict

  3. volume of fluid is too low

Types of shock

  • cardiogenic - heart not working

  • obstructive - blockage of blood vessel

  • Disruptive - most common - fluid mostio/movement issue

    • Hypovolemic/hemorrhagic - loss of fluid (trauma

    • Neurogenic - neurons not functioning (brain/CNS injury)

    • Phsychogenic - emotional trauma

    • septic - entire bacteria infection (lose fluid = hypotensive_

    • anaphylactic - allergic rxn

What is the difference b/w compensated and decompensated shock for LOC

S/S

T

Tachycardia

Tachypnea moving to Bradypnea

Dropping Blood Pressure

Pale to cyanotic skin

Decreasing level of consciousness

Diaphoresis

Anxiety

Treat causes (major bleeds)

Airway management

15lpm O2 via Non-Rebreather Mask

Position of comfort

Keep warm

RTC

Trauma

Bleeding

Hemorrhage and soft tissue trauma

  • Internal vs external hemorrhage

  • Internal blees - distension of cavities (palpate_

  • ecchymosis - bruising/blotching of cavities, pooling of blood under skin

  • minor vs major injuries

  • can involved skin, fat, vessels, muscle, bones, and/or organs

Complications

  • infection

  • tetanus (bacterial infection)

  • gangrene (dead tissue, common in the unhoused)

Closed injuries

  • abscesses (pimple)

  • subungual hematomas (bruise under nails)

S/S

T

Fluid or blood between the nailbed and the fingernail

Clean the injury site

Use a nail drill or heated paperclip to create a hole in the nailbed

Consider fractures or other injuries

  • dermatitis ( skin condition, rash)

  • Myocardial contusions - bruising around the heart (MVI)

  • Internal hemorrhage - ecchymosis + distention

S/S

T

Discolouration of the skin (bruising)

Tenderness, swelling, firmness

Anxiety or restlessness

Pale, cyanotic, moist skin

Nausea and vomiting

Decreasing level of consciousness

Rapid, weak pulse

Dropping blood pressure

  • Severity dependent

  • Minor: Icepack

  • Severe:

  • Treat for shock

  • 15lpm O2 via Non-Rebreather

  • Mask

  • Position ¾ prone

  • Keep warm

  • Rapid transport

Open Injuries

  • Abrasions

S/S

T

Redness

Bleeding

Scrapes

More severe can cover more body ex. road rash

less severe is scraped knees

  • Severity dependent

  • Minor: Clean and dress

  • Severe:

  • clean

  • cover with burn dressing

  • O2

  • ¾ prone

  • keep warm

  • RTC

  • Lacerations

S/S

T

Cuts

Can vary in severity depending on size and depth and location

Severity dependent

Minor

  • clean and dress

Severe

  • direct pressure x2

  • tourniquet

  • treat for shock

  • O2

  • Pos ¾ prone

  • keep warm

  • RTC

  • Avulsions

S/S

T

Partially or fully removed chunk of tissue

(Degloving)

Severity dependent

Minot

  • clean and dress

  • protect skin flap

Severe

  • manage bleeding

  • O2

  • ¾ prone

  • Dress wound

  • keep warm

  • RTC

  • Punctures

S/S

T

Ex. GSW

Any wound that punctures through the skin can be from a pin or a bullet

usually leaves a puncture hole

can be through and through

Minot

  • clean and dress

Severe

  • direct pressure x2

  • Tourniquet

  • Treat for shock

  • O2

  • Pos ¾ prone

  • Keep warm

  • RTC

  • Consider SMR (all GSW to torso get SMR)

  • Major External Hemorrhage

S/S

T

Perfuse Bleeding

  • Direct Pressure

  • Tourniquet

  • treat for shock

  • O2

  • Pos ¾ prone

  • keep warm

  • RTC

  • Consider SMR

  • Epistaxis (Nose bleed)

S/S

T

Bleeding of the nose

Pos sitting

lean pt forward

pinch bridge of nose

place icepack on the bridge of nose if possible

consider facial fractures? what caused it?

  • Impaled objects

S/S

T

  • Control bleeding

  • Manage airway

  • Stabalize the object

  • treat for shock

  • O2

  • Keep warm

  • RTC

  • Consider SMR

  • Do NOT remove the object unless it is impeding BLS ex blocking the airway

  • Object in the airway? use bvm to protect

  • Amputation

T

  • Direct pressure

  • Tourniquet

  • treat for shock

  • O2

  • ¾ prone

  • keep warm

  • RTC

  • Protect and transport the amputated body part in a clean plastic bag on ice but not in direct contact with it. Use saline to clean it.

  • Crush injuries

T

  • Manage injuries

  • Treat for shock

  • O2

  • Keep warm

  • RTC

  • Consider SMR

  • consider Compartment syndrome

  • Apply tourniquets before releasing the pt to prevent trapped toxins from entering the rest of the body

  • Blast injuries

T

  • Control bleeding

  • manage airway

  • treat for shock

  • keep warm

  • RTC

  • consider SMR

Types of bleeds

  • Artery - fast, bright red, spurting

  • Vein - dark red, oozing

  • Capillary - slow leak

Head, Face and Neck injuries

  • Head and Face

    • lacerations

    • extruded eyeball - telfa, damp gauze, bvp mask

    • penetrating

    • impaled

    • airway invovlement

  • Neck

    • lacerations

    • impaled

Burns

Causes

  • Thermal - 2 mins

  • chemical - 20 mins

  • Electrical - look for entry and exit wounds

  • Radiation - prevent exposure

  • * do Not delay RTC. Cool with saline in car. Remove all powders

Severity

  • superficial - epidermis only (sunburn)

  • partial thickness - epidermis and dermis

  • full thickness - epidermis, dermis, subcutaneous (blood is cooked)

Rule of nines

T

  • cool burn (2 or 20 mins depending on type)

  • cover with loose burn dressing (telfa/nonstick)

  • O2

  • Identify life, limb or function threats

  • pos of comfort

  • Keep warm

  • RTC for face, hands or encircling burns, NRTC for others